Effectiveness of Dialectical Behaviour Therapy Group Skills Training for Borderline Personality Disorder in Regional Community Mental Health

Abstract

Borderline Personality Disorder (BPD) is a complex psychiatric disorder characterised by significant and pervasive impairment in personality and interpersonal functioning. Dialectical Behaviour Therapy (DBT) has been extensively empirically evaluated as an efficacious treatment for BPD. However, the complete DBT protocol has demonstrated constraints which limit its feasibility in public mental health settings, particularly in rural areas where budget and workforce resources are most limited. Recent research has prioritised ‘pared-down’ treatment approaches for BPD, identifying the minimum essential elements of effective care, offering greater feasibility for implementation in challenging real-world service environments. Study One provides a systematic review of DBT ‘dismantling’ studies, offering critical appraisal of five studies comparing standard DBT to standalone DBT skills training and/or individual DBT-only. Findings indicated few or no clinically or statistically significant differences between DBT conditions, and suggest that these approaches may be similarly effective in reducing suicidality and self-harm, and may reduce general psychological distress. Overall, the reviewed studies provide modest, preliminary evidence for the use of DBT skills training as a standalone treatment for BPD in real-world clinical settings. The effectiveness of standalone DBT skills training as a treatment for BPD when implemented within community mental health services in regional South Australia is examined. Study Two, a randomised controlled trial (RCT) of 34 women with BPD, is presented in two parts. Part I examined outcomes of symptomology, quality of life and satisfaction with services, compared to pre-intervention levels relative to treatment as usual. A statistically significant improvement in BPD-related symptoms was identified, along with increased self-perceived quality of life in the domains of social relationships and environment. No statistically significant change in quality of life for the domains of psychological or physical health was reported. While participants reported strong satisfaction with services, there was no statistically significant difference between groups. Part II examined impacts on health services usage compared to pre-intervention levels relative to treatment as usual. Results indicated a statistically significant reduction in health services usage for the DBT skills training group participants in the period following the intervention, with significantly fewer emergency mental health presentations, mental health admissions and total days of admission. There was no statistically significant difference between the intervention and control groups for these outcomes. In Study Three, a pre-post comparison of 12 men with BPD examined outcomes of symptomology, quality of life and client satisfaction with services. A statistically significant improvement in BPD-related symptoms was identified, as was increased self-perceived quality of life in the domain of social relationships. No statistically significant change in quality of life for the domains of psychological or physical health or environment was identified. Participants reported a high level of satisfaction with services. The results support the effectiveness of group DBT skills training as a treatment for BPD in community mental health settings. These findings are of particular import for rural areas, offering a practical approach to BPD which can be integrated within existing services, without need for increased funding or workforce resources.